Family Health Exam 1 Flashcards
Acrocyanosis
Acrocyanosis” refers to cyanosis found in the extremities, particularly the palms of the hands and the soles of the feet. It can also be seen on the skin around the lips. Acrocyanosis is often normal in babies, as long as no cyanosis is present in the central part of the body.
Active Acquired Immunity
Active immunity is created by our own immune system when we are exposed to a potential disease-causing agent (i.e., pathogen).
Apgar Score
Score of 7-10 = within desired limits
Score of 4-6 = oxygen, suctioning, stimulate the baby, rub the baby’s back.
Score of 0-3 = full code / resuscitation
A = Activity (Muscle Tone) 0 = absent; 1 = flexed arms and legs; 2 = active
P= Pulse 0 = absent, 1 is <100bpm; 2 is >100 bpm
G = Grimace (reflex irritability) 0 = floppy; 1 = minimal response to stimulation; 2 = prompt response to stimulation
A = Appearance (skin color) 0 = blue or pale; 1 = pink body, blue extremities; 2 = pink
R = respiration 0 = absent; 1 = slow and irregular; 2 = vigorous cry
Barlow Maneuver
Baby is on its back
Palm is in the palm of the examiner
Thumb is on the medial aspect
fingers on the lateral aspect
Do the test one side at a time
Bring the leg inward (adduction) and push backwards (towards the bed).
This tests if the hip is sublaxable (can be easily dislocated of the acetabulum)
Ortolani Maneuver
Baby is on its back
Palm is in the palm of the examiner
Thumb is on the medial aspect
fingers on the lateral aspect
Do the test one side at a time
Bring the leg outward (abduction) and pull anteriorly (to the front).
This tests if the hip is coming out of the socket
Brazelton Neonatal Assessment Scale
Also called the Neonatal Behavioral Assessment Scale (NBAS)
It is a neurobehavioral assessment scale designed to describe the newborn’s responses to his/her new extrauterine environment and to document the contribution of the newborn infant to the development of the emerging parent-child relationship.
It is used to examine the effects of prematurity, low birthweight, undernutrition, and a range of pre-and perinatal risk factors, the effects of prenatal substance exposure, environmental toxins, temperament, neonatal behavior in different cultures, prediction studies, and studies of primate behavior.
Caput succedaneum
Caput succedaneum is swelling of the scalp in a newborn across the midline. It is most often brought on by pressure from the uterus or vaginal wall during a head-first (vertex) delivery. Swelling and bruising usually occur on the top of the scalp where the head first enters the cervix during birth.
Cephalohematoma
Cephalohematoma is a minor condition that occurs during the birth process. Pressure on the fetal head ruptures small blood vessels when the head is compressed against the maternal pelvis during labor or pressure from forceps or a vacuum extractor used to assist the birth.
Chemical conjunctivitis
When eye drops are given to newborns to help prevent a bacterial infection, the newborn’s eye(s) may become irritated. This may be diagnosed as chemical conjunctivitis. Symptoms of chemical conjunctivitis usually include mildly red eye(s) and some swelling of the eyelids.
Congenital dermal melanocytosis (Mongolian Spots)
The term congenital dermal melanocytosis refers to one or more birthmarks. They are flat blue or blue/grey spots with an irregular shape that commonly appear at birth or soon after. Congenital dermal melanocytosis are most common at the base of the spine, on the buttocks, back and shoulders.
Dubowitz / Ballard tool
The Ballard Score is used to assess gestational age / maturity. A lower Ballard Score indicates lower gestational age and vice versa.
Ballard’s score is most accurate when performed within the first 12-20 hours of life.
Six neuromuscular markers are assessed: posture, square window (degree of wrist flexion), arm recoil, popliteal angle (degree of knee flexion), scarf sign (ability to extend the infant’s arm across the chest past midline), and heal to ear extension.
Seven physical characteristics are also evaluated: skin, lanugo, plantar creases, breast, eye and ear, and genitals.
A normal pregnancy can range from 38-42 weeks, so this is a normal Ballard score. The full Ballard range is -10 to 50.
SGA babies
SGA = Small Gestational Weight –> at risk for chromosomal abnormalities, malformations, congenital infections like rubella and cytomegalovirus.
Would have a low Ballard score.
nursing interventions are to assure the baby is appropriately fed, prevent hypoglycemia with glucose monitoring and possibly glucose interventions; maintain the baby’s temperature; monitor serum hematocrit (normal is 45-65%), assess for possible infections.
LGA
LGA = Large Gestations Age
LGA babies are at risk for birth injuries due to their disproportionate size and might also have genetic or congenital disorders, frequently are male, and are also at risk for congenital heart disease “happy chubby blue male infant”
Nursing interventions are focused on observing for potential complications (particularly if the mom is diabetic) and management of birth injuries like a clavicle fracture, facial nerve injury, erb-duchenne palsy, klumpke paralysis, phrenetic nerve palsy, and potential skull fracture.
Epstein Pearls
Epstein pearls are small, harmless cysts that form in a newborn’s mouth during the early weeks and months of development. They contain keratin and usually go away within a few weeks. The bumps contain keratin, a protein that occurs naturally in human skin, hair, and nails.
Erb-Duchenne paralysis (Erb palsy)
Erb’s palsy or Erb–Duchenne palsy is a form of obstetric brachial plexus palsy. It occurs when there’s an injury to the brachial plexus, specifically the upper brachial plexus at birth. The injury can either stretch, rupture or avulse the roots of the plexus from the spinal cord.
Erythema toxicum neonatorum
Erythema toxicum neonatorum (ETN) is a skin condition in newborns. Usually, ETN looks similar to acne. Red patches or small, fluid-filled bumps (pustules) may form on the baby’s face, limbs or chest. ETN isn’t dangerous and usually goes away on its own.
Finnegan Neonatal Abstinence Scoring Tool (FNAST)
reviews CNS disturbances, metabolic/vasomotor/respiratory disturbances, GI disturbances to create an overall score to assess infants exposed in utero to psychoactive drugs like opioids/opiates.
Score of 8+ indicates need for pharmacologic therapy.
All opioid exposed infants should have continuous monitoring via a cardiorespiratory monitor or pulse oximetry due to the potential for respiratory depression.
Infants should be scored every 3 hours throughout their hospital stay, but might need to be evaluated more frequently.
Habituation
If left in the same environment, over time they become accustomed to their surroundings and pay less attention to them. This process is called habituation. However, the moment something new happens, infants are ready to pay attention again.
harlequin sign newborn
Harlequin colour change appears transiently in approximately 10% of healthy newborns.1 This distinctive phenomenon presents as a well-demarcated colour change, with one half of the body displaying erythema and the other half pallor. Usually occurring between two and five days of age, harlequin colour change has been seen as late as three weeks of age.2 The condition is benign, and the change of colour fades away in 30 seconds to 20 minutes. It may recur when the infant is placed on her or his side.
Jaundice
Jaundice in newborn babies is common and usually harmless. It causes yellowing of the skin and the whites of the eyes.
Bilirubin
Bilirubin levels indicate jaundice.
Normal ranges:
<8.0 mg/dL for <24 hrs
<12 mg/dL for <48 hrs
<15 mg/dL for <5 days
Pathological jaundice
bilirubin is elevated within the first 24 hours of life. This often results from blood incompatibility, sepsis, infections like rubella, toxoplasmosis, occult hemorrhage, and erythroblastosis fetalis.
Pathological jaundice requires immediate nursing intervention - start with feeding (feed but also poop out the dead RBCs), warming, and then phototherapy.
Coombs
Tests mom & baby Rh factor
If the mom has a negative Rh factor and the baby has a positive Rh factor, the mother’s body will trigger antibodies against the baby’s positive antigen. These antigens will then mix into the baby’s body, which can be life threatening for the baby since their own body will be attacking their blood.
Give Rhogam if mom is Rh- and baby is Rh+
Newborn Glucose
Used to identify the glucose levels of the baby.
Normal range: 40 - 150 mg/dL